| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
77 |
76 |
$10K |
| A4554 |
Disposable underpads, all sizes |
120 |
120 |
$6K |
| B4100 |
Food thickener, administered orally, per ounce |
26 |
25 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
25 |
24 |
$2K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
12 |
12 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14 |
14 |
$2K |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$461.88 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
12 |
12 |
$354.47 |